Medicaid expansion and common misconceptions

I would like to respond to Representative Emerick's recent letter regarding Medicaid expansion and some common misconceptions regarding the impact of expansion on community health centers.

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seacoastonline.com

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Posted Jan. 14, 2014 at 2:00 AM

Posted Jan. 14, 2014 at 2:00 AM

» Social News

To the Editor:

I would like to respond to Representative Emerick's recent letter regarding Medicaid expansion and some common misconceptions regarding the impact of expansion on community health centers.

As a federally qualified health center, Lamprey Health Care is fortunate to receive fixed amounts of state and federal grant funding to support our mission of providing high quality primary health care without regard to an individual's ability to pay. Medicaid payments actually represent our largest third-party source of payment, providing coverage to over 25 percent of our patients. Contrary to Representative Emerick's example, Medicaid reimburses health centers in a manner structured to ensure that our costs are covered, so that high quality care can be delivered effectively in the outpatient primary care office. This is the most appropriate setting for preventive primary care, which is best for the patient and least expensive for the payer, be it an insurance company or a public program.

I think that it is important to point out that organizations such as Lamprey Health Care are much more than a free clinic for those faced with no alternatives. Lamprey Health Care is a medical home to over 16,000 patients in southern N.H., most of whom chose us because of convenience, community orientation and the fact that we deliver the highest quality of care. So much so, that the National Committee on Quality Assurance has designated all three of our facilities as Level III Patient Centered Medical Homes, their highest level of certification.

There is a common misconception that community health centers will suffer as a result of expanded Medicaid coverage and the Affordable Care Act (ACA). Based on the experience in Massachusetts, this was not the case. The demand for services at community health centers increased after health care reform, many of which have become the provider of choice in the community. Another common misconception is that other funding sources and private philanthropy will fill the gaps in funding. The reality is that in recent years fixed subsidies and community benefit funding for services to the uninsured have already decreased in the face of enormous growth in need. Increasing access to coverage would actually allow these resources to serve greater numbers of people.

What does expansion of Medicaid mean to those without the resources to purchase health insurance? Improved access to primary care services, such as those provided at Lamprey Health Care; improved access to diagnostic services such as laboratory tests, x-ray and ultrasound; and improved access to prescription medications. Presently, most of these services are neither consistently available, nor affordable for those who lack basic health coverage. The health plans and subsidies available through the ACA were designed with the idea that the poorest individuals would be eligible for coverage through expanded Medicaid.

In N.H., Medicaid is only available to children, pregnant women and the disabled. This leaves a large number of the state's labor force employed in seasonal industries or the construction trades without coverage that they can afford. Affordability is a substantial barrier to accessing care, whether it manifests in the form of the out-of-pocket fees and deductibles or substantial monthly insurance premiums. We are all feeling the burden of higher out of pocket fees and premiums. The failure to expand the availability of coverage does not eliminate the needs of those most affected by this. This need truly remains.

We would like to encourage Representative Emerick and all members of town, county and state government to learn more about community health centers and the services they provide to communities throughout New Hampshire.